Welcome to the new decade! 2020 is here! Artificial Intelligence - better than humans?

Happy New Year! Welcome to the 3rd decade of the 21st Century!

2020 has arrived on our doorstep and we had welcomed a new decade. We have left behind 2010s with many contributions to the development of eye care and eye health. As anticipated our world is continuously digitized so is the field of ophthalmology. Telemedicine is here so are doctors on call coming to the rescue with Uber/Lyft like on demand care.

The other day a friend of mine was bedridden with a severe cold and she later confessed that it was easy enough to pay $99 fee for an online doctor on call local to Orange County service that sends a board certified primary care physician to patient's house to examine and treat her. No leaving the house, waiting in the waiting room of urgent care or emergency room department, or lengthy insurance paperwork was necessary. With a click of a button a doctor appeared at her door step.  I believe the field of ophthalmology is going in a similar direction.  More and more services are available for online contact lens dispensaries.   However, these services still rely on a prescription by a real doctor who patient needs to see, however, a shift is on the way to automated refraction available online. It is not accurate at this point, but this decade may change that.

A significant challenge of he world wide web is a deluge of available information and one's ability to sift through it in a meaningful way. One can google the symptoms and "self diagnose" his or her problem.  Over and over again I have seen patients in my chair ridden with anxiety after reading about diagnosis that is not remotely relevant to his or her condition.  I have to take the time to disspell "Dr. Google"'s diagnostic techniques and reassure the patient.

There is a caveat to the technology in its early adaptation period in health care. At this point, in my opinion there is no single Google search or Healthgrades reference that can diagnose or treat any particular disease.  A board certified physician is still the gold standard of care. There is no substitute to a face to face human to human interaction where subtleties of clinical presentation, physical exam, mental state, socioeconomic situation as well as ability to process comprehensive medical information in the year 2020.

As a practicing physician, I like thousands of my colleagues, had to embrace Electronic Health Records (EHR), that have digitized a medical chart.  Now, the new task is to let not technology mislead the patient and their well being.  A fine line of balancing the use of technology will be walked by all who are involved in direct care, and that is what I will personally watch evolve this decade with great anticipation.

FROM THE GLAUCOMA RESEARCH BENCH DIRECT TO CLINIC

Recently I was invited to a private tour of our local Orange County, CA medical ophthalmic device  company Glaukos located in San Clemente, CA.  Here are the pearls of my visit that I would like to share with you.

As of 2012 Glaukos broke out into glaucoma research and clinical care field with a new and pioneering device Istent that changed the treatment of glaucoma forever.  For patients diagnosed with glaucoma, it is a life long struggle to keep the intraocular pressure as low as possible.  That commitment requires constant discipline to take pressure lowering drops, sometimes up to three times a day.  Imagine your elderly relative or busy colleague that runs at the pace of our modern life who has to stop three times a day for 5 minutes at a time to put one drop into each eye and wait 5 minutes for absorption of these drops.  What if that patient is driving on a freeway and stuck in traffic, will he or she miss the drops? What if he or she forgot the drops at home?  Every time a patient misses the drops, glaucoma chips away at the optic nerve and leads to slow but permanent peripheral vision loss.

The breakthrough idea about the original Istent device back in 2012 was that the it lowered intraocular pressure in patients who have undergone cataract surgery and Istent implantation at the same time.  Istent was and is the smallest medical device that has been successfully implanted in human body to date.  The initial studies showed that patient had additional decline in intraocular pressure  by 15-20% in large populations in clinical trials compare to cataract surgery alone.  The original Istent required a bit of a steep learning curve for an ophthalmic surgeon.  Encouraged by the first five years of wide clinical implementation and receptive to surgeon user feedback, Glaukos developed a user friendly Istent Inject when two Istent devices with modified shape are implanted by a surgeon at the time of cataract surgery.

I have been implanting Istent since 2017 since have done over a 100 implantations at this point.  I was the first surgeon that implanted Istent Inject at out Newport Bay Surgery Center since it was introduced late in 2017.  I have seen excellent results where intraocular pressure decline in patients who have undergone combined cataract surgery and Istent implantation.  There are no side effect that we see with traditional glaucoma surgery that requires large implants in the eye.  There are no additional risks to the cataract surgery when Istent inject is added to the planned cataract removal.

If a patient can reduce dependence on glaucoma drops, not only is it a relief in time consumed placing the drops, it also leads to reduced risks of side effects associated with use of pharmaceutical agents, and the relief of financial burden placed by the costs of drops to the patient.

I am looking forward to offering that latest Minimally Invasive Glaucoma Surgery (MIGS) which includes Istent Inject implantation for all of my patients with glaucoma at Clarity Eye.  I feel strongly that Istent Inject is the safest medical device that I have placed in the eye since the advent of the intraocular implant.  Soon, we will have a decade of data from the pivotal studies on the original Istent implantation. With every new generation of Istent, just like every new generation of Iphone, the safety profile, and efficiency of the Istent device has increased manifold and now should be an attractive option to any patient who is looking to reduce or eliminate dependence on intraocular pressure lowering medication.  If you or your family member have glaucoma, ask your surgeon about Istent Inject!

GLAUCOMA PREVENTION IS POSSIBLE

As a Board Certified Ophthalmologist, I like to share news about eye health with my patients that will enhance their life.  I strongly believe that lifestyle choices affect your eye health.  Now we have several studies to confirm that we can prevent glaucoma  Dr. Pasquale of Cornell University emphasized that there is not any particular proven strategy to prevent glaucoma, but he shared six suggestions that show promise:

1. Eat many green, leafy vegetables. “These are a great source of nitrates that can be converted into nitric oxide,” Dr. Pasquale said. “In primary open-angle glaucoma, there is impaired nitric oxide signaling.” There are drugs in development that will target this highly druggable pathway, he added.

2. Protect the eyes from the sun starting at an early age. “There is considerable evidence that sunlight reflected off water and snow may be associated with an increased risk of exfoliation syndrome,” Dr. Pasquale said. “A good strategy to start in your younger years is to protect your eyes from the sun.”

3. Maintain good dental health. This strategy may sound odd initially, but there is a theory that periodontal disease could trigger neuroinflammatory markers that reside in the base of the tooth and travel via the blood to the optic nerve. “At least two studies show that those with poor dental health had a greater open-angle glaucoma risk,” he said.

4. Exercise in moderation. Moderate exercise is associated with a lower intraocular pressure (IOP), but vigorous exercise appears to be associated with primary open-angle glaucoma.

5. People should see an ophthalmologist regularly, especially if there is a family history of glaucoma.Dr. Pasquale is involved with a NEIGHBORHOOD consortium focused on finding common gene variants for glaucoma. “We hope this effort will translate into people finding out earlier if they are at an increased risk for glaucoma,” Dr. Pasquale said.

6. Maintain a healthy body weight. A higher body weight and body mass index are associated with metabolic syndrome and diabetes risk. They could also lead to an elevated IOP. However, someone who is thin, has a low body mass index, low blood pressure, and cold hands and feet could have a disturbed autoregulation, leading to an increased risk of normal tension glaucoma.

Shingrix Vaccine is a MUST for patients 50 and older to prevent painful shingles outbreaks

A controversy existed because the American Academy of Ophthalmology and the American Dermatologic Society recommended that patients over 50 years be vaccinated for shingles but the CDC recommendation was 60 years and above, Pepose said.

Now all recommendations are in line.

In October, the U.S. FDA indicated all healthy adults over 50 years be vaccinated and Shingrix (GSK) was selected as the preferred vaccine.

There are 1 million new cases of zoster annually in the U.S. versus 35,000 new cases of herpes simplex keratitis (HSK), he said. Along with 100,000 new cases of zoster ophthalmicus.

One in two people over 70 years will get shingles in their lifetime, he said.

The risk of stroke increases by 30% within 1 year of zoster and 4.5 times following herpes zoster ophthalmicus, Pepose said.

“This is thought to be related to varicella zoster virus (VZV) travelling down the afferent sensory fibers of the trigeminal nerve to internal carotid and its intracranial branches,” he said.

There are common misconceptions about shingles, he added.

It was thought that the vaccine could perhaps curb immunity in older patients.

“It turns out the incidence of zoster was increasing with age even before the production of the vaccine,” Pepose said.

The vast majority of zoster patients are healthy, he said. The mean age of onset for shingles is 52 years.

The ocular disease usually occurs weeks after.

“Although zoster is more severe in immunocompromised individuals, 92% of zoster patients are healthy,” he said.

The risk of PHN increases with age. PHN is associated with depression and is the leading cause of suicide in chronic pain patients over 70 years.

“Both varicella and varicella vaccine establish an immune response and lifelong neuronal latency, but changes in cell-mediated immunity lead to reactivation,” Pepose said.

He added that only 24% of eligible patients aged 60 years or older have been vaccinated.

“All patients over age 50 years should be vaccinated. I think you’ll have to be cautious with this in first quarter as the reimbursement is going through for the insurance company,” he said.

Zoster trials are ongoing.

“In those who currently have zoster, I wouldn’t vaccinate after it clears but wait a year and then vaccinate. I don’t think there is any evidence that proves the vaccine causes reactivation,” he concluded. – by Abigail Sutton

Reference:

Pepose JS. The shingles vaccine and zoster ophthalmicus. Presented at: Hawaiian Eye; Jan. 13-19, 2018; Wailea, Hawaii.

I have exciting news! My office started carrying a leading  ANTI AGING skin care line, Rodan & Fields. Dr. Rodan & Dr. Fields are two dermatologists, who created acne fighting product Proactive in late 90s. In early 2000s they have extended their expertise into the anti aging skin care line for men and women interested in looking their best every day. The new line has a sun protection and age defying regimen REVERSE, as well as a skin maintenance and rejuvenation kits REDEFINE.  There is an improved acne fighting line UNBLEMISH as well for younger patients, and people suffering from adult acne.  The most revolutionary product to me as an ophthalmologist is LASH BOOST which GROWS your lashes over 2 months of use. NO MORE EXTENSIONS!

I am so excited to be part of R & F team, and to be able to extend the years of research from the leading dermatologists to benefit my patients.

Summer is the perfect time to protect your face from sun damaging rays as well as rejuvenate and repair skin, boost eyelashes and eliminate fine lines.

Starting June 22, 2017 purchase skin care kit+LASH BOOST to receive 20% off.

*First three patients in the month of June to come to our office for an eye exam and mention this ad, will get a FREE sample of GLOW packet for skin rejuvenation and 10% towards LASH BOOST purchase!* 

See more at: drkurteeva.randf.com and shop the skin care line of your choice.

Have you noticed your "sunkissed" eyes looking yellow lately?

Southern California boasts 281 sunny days a year. Sunny days means tremendous amount of direct ultraviolet radiation exposure to our skin and eye surface. Without the physical protection of sunglasses and a wide brim hat, continuous UV radiation results in chronic and permanent changes on the white part of the eye called conjunctiva. 

Conjunctiva when healthy is smooth, moist, and white; it has a glistening reflection from an abundant tear film covering it. Sun leads to mutations in the way elastin and collagen, the soft tissue building blocks, are synthesized on the eye surface and dermis of the skin. These mutations lead to permanent deposition of yellow, fatty, elevated tissue on the white of the conjunctiva. These striking deposits grow over time to unsightly and commonly irritating lesions called pingueculi. These areas are frequently easily irritated by wind or allergies and turn the whole eye red.  When the fatty deposits cross over the cornea, the clear window of the eye, the clarity of vision is affected by the pulling of the scar affecting the optics of the eye.

Most people are not aware that removal of the pterygium is a short outpatient procedure with minimal down time. It is done at an outpatient facility and most patients return to desk jobs within two days. With the use of doctor prescribed eye drops the healing process continues for a month after surgery until the eye looks “pristine” and white as it did before sun damage ravaged the ocular surface.

Surfers and farm workers are people that are most affected by pterygia. People who spend significant hours outdoors golfing, sailing, fishing or playing tennis maybe at risk as well if sunglasses are not worn. Some people have a genetic predisposition to develop sun damage

as early as teens. For those patients the cosmetic effect of the pterygium or even pingueculum is quite significant.

Our office speciliazes in identifying and treating sun damage of the ocular surface with medical options as well as a more definitive surgical removal.

Grapes may support ocular health

Compounds found in grapes may help protect against eye disease, according to new research led by researchers at the Bascom Palmer Eye Institute, University of Miami Miller School of Medicine. The study showed that a diet supplemented with grapes was able to counter damage from oxidative stress and preserve retinal structure and function in a laboratory model of retinal degeneration, the university said. The study was funded by the California Table Grape Commission; researchers investigated whether a diet supplemented with grapes, in the form of whole grape freeze-dried powder, would protect the photoreceptors of the retina from degeneration induced by acute oxidative stress. Mice were fed the grape-supplemented diet (corresponding to about 3 servings per day for humans), a sugar-matched control diet, or a normal chow control diet. Both retinal structure and function were preserved in the mice consuming the grape-enriched diet, where they maintained their retinal thickness, the quantity of photoreceptors, and the amount of photoreceptor activity, despite the elevated oxidative stress conditions. Conversely, in the non-grape consuming group, retinas were damaged, displaying holes and lesions, and with a significant decrease in thickness.

More toddlers suffer eye burns from laundry packets, study says

(CNN)From 2012 to 2015, the number of chemical burns to the eye linked to laundry detergent packets rose more than 30 times among young children, a new study says. More than 1,200 3- and 4-year-olds received such burns in that time period, according to the research published Thursday in the medical journal JAMA Ophthalmology.

Single-dose detergent packs, known as laundry packets or pods, entered the mass market in 2012.

"Each pod consists of a detergent mixture wrapped in a water-soluble film, made up of a proprietary polyvinyl alcohol polymer," said Eric J. Moorhead, president and principal scientist of Good Chemistry LLC, a consulting firm.

Laundry detergent pods are 'real risk' to poison kids

"The liquid detergent in the pods is not the same as regular liquid detergent. It has a higher concentration of surfactants, chemicals that are responsible for stain removal," said Moorhead, who was not involved in the new study. "At high concentrations, these ordinarily safe ingredients can cause irritation, especially in sensitive areas like the eyes."

'Among the worst chemicals'

Among kids between 3 and 4 years old, the number of chemical burns in the eye caused by laundry detergent packets increased from 12 instances in 2012 to 480 in 2015. Proportionally, the total chemical eye injuries associated with the packets increased from 0.8% of all burns in 2012 to 26% in 2015.

Children can injure themselves when the packets break and the contents squirt into one or both eyes, or when the contents leak onto the children's hands and they rub their eyes.

Most of these burns happened in the home, where kids are playing with the brightly colored packets, "wondering if they're toys, if they're candy," said the lead researcher, Dr. R. Sterling Haring of Johns Hopkins University. They're neither.

Laundry packet poisonings increase in kids

The detergents inside the pods "are among the worst chemicals that the eye can be exposed to," Haring said: Detergents are alkaline in nature, and alkaline burns are typically more severe than acid burns in the eye. "They penetrate deeper, they burn faster, and they are more caustic to the tissues in the eye itself."

Because the cornea doesn't have blood vessels, it doesn't heal well, so if you scar it with detergent packet chemicals, "there's a high risk of long-term vision impairment," Haring said.

"We'd done another study a few months ago that showed that small children are at highest risk for all types of chemical ocular burns, and that kind of flew in the face of conventional wisdom," he said. "They always thought that working-age men were the highest risk group: working in factories, splashing chemical in their eyes."

Instead, he and his colleagues were surprised to find that young children have a 50% higher risk than the highest-risk adult, Haring said. Once that news got out, community physicians insisted that the cause was laundry detergent packets. Haring and his team discovered that they were right. Their study concludes with recommendations that parents properly store these packets and that manufacturers consider new, redesigned packaging.

In essence, these recommendations "are already in play," said Brian Sansoni, vice president of sustainability initiatives at the American Cleaning Institute, which represents the US cleaning products industry.

He said the new study analyzed data prior to the new safety standards that were published in December 2015 by ASTM International, formerly American Society for Testing and Materials International, a non-profit that develops voluntary consensus standards for consumer manufacturers. The American Cleaning Institute helped identify proper standards for the packets.

Following publication of the safety standards, Procter & Gamble, the company that makes Gain and Tide brand laundry detergent pods, launched ad campaigns to raise awareness of the dangers and made its packaging more difficult for small children to open. Other companies also followed suit.

"Make sure you keep these products up and away from children -- like a lot of household products," said Sansoni.

What should parents do?

Dr. Michael Grosso, chairman of the department of pediatrics and chief medical officer at Northwell Health's Huntington Hospital in Huntington, New York, said parents need to worry about these laundry packets and keep them out of the way.

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"It's not only eye injuries. Children will also swallow these," said Grosso, who was not involved in the study. Eye injuries caused by the packets "can be quite serious," he added.

"The majority of individuals will recover their vision after this kind of injury," he said. However, these burns can be "very, very painful. They require extensive emergency treatment and extensive follow-up treatment by an ophthalmologist."

The first thing parents should do is "prevent this by keeping these pods out of the way. They need to be kept up high in cabinets beyond the reach of a preschool child, the group that's most at risk."

If a child does get detergent in their eye, a parent should immediately irrigate the child's eyes.

"Cool tap water, as much as possible, as soon as possible," Grosso said. "And then the very next step would be a trip to the emergency department."

Haring echoed this advice. "Take your child and put their eye under cool water under the faucet and flush it with cool water for 20 minutes," he said, noting that if the burn is extremely severe, some loss of vision could occur.

"Don't stop and take them to the hospital. Don't call and wait for an ambulance to show up. Flush the eye with cool water before you do anything else," Haring said. "That's going to be the deciding factor about long-term outcome for this injury."

Dry Eye Relief Reinforced

There are estimates of 16 million dry eye patients in the United States that report symptoms to eye care professionals.  For these patients, good news in the form of Xiidra could not have come sooner.  Manufactured by Shire, Xiidra, aka lifitigrast opthhalmic solution,  a lymphocyte function-associated antigen 1 antagonist, was approved by the FDA for dry eye disease, on July 11, 2016.  

This is exciting news in the world of dry eye treatment.  Since 2005 Restasis, aka cyclosporine ophthalmic emulsion, (Allergan) was the only prescription solution available in the US to our dry eye patients.  Twelve years in the making, Xiidra is a new alternative to patients sensitive to Restasis, and who do not get complete relief from punctal plugs or frequently used artificial tears and other lubricants.

The drug’s safety and efficacy were assessed in more than 2,500 patients in four separate, randomized controlled studies. The results of the studies found that patients treated with Xiidra demonstrated improvement in their signs and symptoms of dry eye compared with patients treated with placebo.

Since FDA approval I have seen patients benefiting from Xiidra use.  When used twice daily, relief is felt two weeks after medication is started.  The only side effect that has been reported by the studies and my patients is a transient metallic taste after the drop is placed in the eye.  This fades with time and is less notable after persistent medication use.  

I am excited to see my patients using Xiidra long term and fighting the chronic inflammatory nature of the dry eye disease.  Currently first month supply is provided for free by the manufacturer given doctor's prescription.  Ask our office about your dry eye relief.

Cataract surgery linked to reduced mortality by 30%

Researchers evaluated the association between cataract surgery and mortality in a 5% random sample of U.S. Medicare beneficiaries. Overall, those who had cataract surgery lived longer.

Data was collected over a 10-year period from a cohort of more than 1.5 million patients.  This is the largest study of its kind making the results more valid since the sample size was so high.  Patients who had cataract surgery had a nearly 30% less mortality compared with those who did not have cataract surgery.

The association between extended life span and cataract surgery was significant outside of differences in systemic health problems like hypertension, high cholesterol and diabetis.  The association was strongest in women, in 80 to 84 year olds, and in those living in Western states.

The authors of this study hypothesize that cataract surgery improves a patient’s ability to care for themselves and remain physically and socially active, thus prolonging their life.

New Glasses Promise a Solution to Color Blindness

About 10 per cent of the population is color blind and simply can't perceive as many colors as those with normal vision. There has never been any way to correct the condition but now, a U.S. company claims they have created glasses that can open up a world of color to users. But some eye experts remain skeptical. Color blindness, or colour vision deficiency, as doctors call it, is more than just a nuisance. Most with the condition can't distinguish red from green and have trouble with aspects of everyday life. They can't become pilots, firefighters, electricians, police officers or take part in several other professions. An estimated 2.6 million Canadians are color blind, most of them men, because of a missing or mutated gene on their X-chromosome. There are different forms of the condition, but most people with a moderate form of red/green color blindness can correctly identify just five crayons from a standard box of 24. Now, the inventors of a brand of glasses called EnChroma say they have found a fix that is helping to bring the color back into users' lives. The EnChroma glasses don't work for every form of color blindness; in fact the company says they are effective in approximately 80 per cent of cases. But they say their glasses make colors appear brighter and more saturated. Users report that they can distinguish certain colors faster and more accurately. The company says the solution was discovered accidentally, when glasses provided to surgeons to help them distinguish tissue from blood during laser surgery also seemed to fix color vision. Devyn Vasseur is color blind and says the first time he tried the EnChroma glasses, he couldn't believe his eyes. "I looked up and I was like, Wow. Experiencing all these colors as an adult for the first time is indescribable," he says. Thanks to a series of testimonial videos showing people trying on the glasses for the first time, sales have exploded for the glasses, which cost about $400 a pair. "This year alone, we have sold over 10,000 pairs of eyewear," says Donald McPherson, the co-founder of EnChroma. But some ophthalmologists are skeptical, including Dr. Sam Markowitz of the Canadian Ophthalmological Society and Toronto Western Hospital, who says other products claiming to fix color blindness have come and gone. He would like to see hard research that show the glasses actually increase the number of colors users can see. "I would prefer to see validated color testing," he said. EnChroma says it's planning to do that and is also expanding into contact lenses that color-correct too. For more information, please visit: http://www.ctvnews.ca/sci-tech/new-glasses-promise-a-solution-to-colour-blindness-1.2669188 

Be EYEware on Halloween night

 

While they may be the perfect finishing touch on a costume, non-prescription cosmetic contact lenses can wreak havoc on your vision. Below are four ways that over-the-counter decorative contact lenses can seriously harm your eyes:

Corneal abrasion

Over-the-counter lenses are not fitted and sized for the person wearing the contacts, so they can easily scrape the outer layer of the eye. The resulting corneal abrasions can cause redness, light sensitivity, discharge, pain, plus the feeling that something is lodged in the eye.

Corneal ulcer

Costume contact lenses can literally create an eye sore called a corneal ulcer, with symptoms similar to corneal abrasions. The ulcers sometimes appear as a white dot on the iris, the colored part of the eye, and may require treatment with medicated eye drops. When the ulcers heal, they can scar over and permanently and adversely affect vision.

 

Infection

 

Both corneal abrasions and ulcers create openings in the eye, making them more vulnerable to bacteria, viruses and amoebas. All of these organisms can cause serious eye infections known as keratitis. A 2011 study found that wearing cosmetic contact lenses increased the risk of keratitis by more than 16 times. Some infections, such as herpes simplex, can be recurring and difficult to eradicate, while a number of bacteria have become resistant to common antibiotic eye drops.  

 

Scarring

 

In the most extreme cases, complications from wearing costume contact lenses may end in blindness or require surgery. For instance, extensive scarring from an infection can distort the cornea or make it opaque, requiring a corneal transplant to restore vision. 

If You Use Your Computer or Mobile Device At Least 7 hours a Day, You Have Dry Eyes

MORE SCREEN TIME EQUALS DRY EYES

Office workers who spend long hours looking at computer screens have changes in their tear fluid similar to people with the disease known as dry eye, according to a study from Japan.

The protein MUC5AC, secreted by cells in the upper eyelid, makes up part of the normally occurring mucus layer, or “tear film,” that keeps the eye moist. But study participants with the most screen time had MUC5AC levels nearing those of people with diagnosed dry eye.  Dr. Uchino, an ophthalmologist at the School of Medicine at Keio University in Tokyo, told Reuters Health: “When we stare at computers, our blinking times decreased compared to reading a book at the table”.  People staring at screens also tend to open their eyelids wider than while doing other tasks, and the extra exposed surface area in addition to infrequent blinking can accelerate tear evaporation and is associated with dry eye disease, he said.

Dry eye may be chronic for some but can be managed with over the counter or prescription eye drops. 

Past research suggests that up to 5 million men and women over age 50 in the United States suffer from dry eye disease, the researchers write in their report. In Japan, tens of millions of people report some dry eye symptoms, often associated with computer work, they add.

 In the study above, 7 percent of men and 14 percent of women were diagnosed with ‘dry eye disease,’ meaning they reported symptoms of eye problems like irritation, burning or blurred vision and had poor quality or quantity of tear film, according to the tests.  Overall, participants looked at screens for work for just over 8 hours a day and had an average of about 6.8 nanograms of MUC5AC per milligram of protein in each eye.

However, people who worked with computer screens for more than 7 hours per day had an average of 5.9 ng/mg of MUC5AC, compared to 9.6 ng/mg for people who spent fewer than 5 hours daily with screens.  Similarly, people with definite dry eye disease had an average of 3.5 ng/mg of MUC5AC compared to 8.2 ng/mg for people without the disease.

“Mucin is one of the most important components of the tear film,” said Dr. Yuichi Hori, who was not a part of the new study. “Mucins (like MUC5AC) function to hold water on the ocular surface of the epithelia that synthesize them, hence, they are major players in maintenance of the tear film on the ocular surface,” Hori told Reuters Health by email.  Concentration of the protein was also lower for people with symptoms of eye strain than for people without symptoms, according to the results published in JAMA Ophthalmology.

HELP RELIEVE SYMPTOMS

People with dry eyes at work tend to be less productive and are more likely to be depressed, according to previous studies, Uchino said. Office workers who are worried about dry eye can make some simple changes to decrease their risk, Uchino said.“The exposed ocular surface area can be decreased by placing the terminal at a lower height, with the screen tilted upward,” Uchino said.

Doctors also recommend using a humidifier at the office and avoiding being in the direct path of the wind from an air conditioner, he said. “We advise the office workers suffering from ocular fatigue and dry eye symptoms that they should blink more frequently in an intended manner during (screen use), and that they should use artificial tears,” Hori said.

Adopted by Dr. Kurteeva from Reuters Health and  JAMA Ophthalmology, June 5, 2014.

Study: cataract patients who undergo surgery live longer

Study: cataract patients who undergo surgery live longer

A new study has found that people with cataract-related vision loss who undergo surgery for the condition have a 40% lower long-term mortality risk than those who opt not to have surgery, the American Academy of Ophthalmology (AAO) said in a press release about a recently published study in its journal.
Researchers evaluated a total of 354 cataract patients aged 49 years and older enrolled in the Blue Mountains Eye Study between 1997 and 2007. Some had undergone cataract surgery while others had not. Subjects were evaluated five and 10 years after baseline exams.
The association between correction of cataract-related visual impairment and reduced mortality risk is not clearly understood, but plausible factors may include improvements in physical and emotional well-being, optimism, greater confidence associated with independent living after vision improvement, as well as greater ability to comply with prescription medications, AAO said. The study acknowledged that participants with cataract-related visual impairment who did not have cataract surgery could have had other health problems preventing them from undergoing surgery, and that these other health problems could partly explain the poorer survival among non-surgical participants.

My practice focuses on diagnosis, evaluation and treatment of cataracts.  If you or your family member need an evaluation, feel free to call our office and schedule a consultation at (949) 650-1863.

Kids! Get outdoors and get rid of glasses!

There has been additional evidence that the more time children spend outside the better chance they have to stay out of glasses.  Majority of school age children need to wear glasses to correct nearsightedness or myopia.  Myopia gets worse during the teenage growth spurt.  It is imperative for elementary school children to have at least an hour of outdoor playtime.  A review of scientific literature found a significant protective association between increasing time spent outdoors and prevalent myopia in nearly 10 000 children and adolescents aged ≤20 years.  Each increase in hours per week of time spent outdoors was associated with a 2% reduced odds of myopia (nearsightedness).  An increase in 7 hours of time spent outdoors per week (1 hr/d) equates to less nearsightedness.

 There are a myriad of possible mechanisms by which spending time outdoors may protect against the development and progression of myopia (nearsightedness). They include increased release of retinal dopamine in response to sunlight (dopamine inhibits axial elongation in experimental myopia,and the protective effect can be blocked by the dopamine antagonist spiperone), increased light intensity outdoors (leading to pupil constriction, increasing depth of focus, decreasing blur, and slowing of eye growth), and the low accommodative demand (focusing) for distance vision. 

Bright light has been shown to be protective of myopia in animal experiments using ultraviolet-free light.  Based on that evidence, one might support an old myth not to read in poorly lit rooms.  More focusing power is required to read in poorly lit rooms and it is the focusing muscle (ciliary body) if placed in overdrive will lead to development of nearsightedness.

Because there is no protective association between indoor sports and myopia, unlike outdoor sports, it suggests that physical activity may be a surrogate for outdoor activity. This is supported by a cohort study with 2 years of follow-up in 156 university students where physical activity time was higher in nonmyopes and associated with hyperopic refraction (0.175 D per hour of physical activity per day; P = 0.015) after adjustment for potential confounders, although there were no differences in objectively measured physical fitness levels between myopes and nonmyopes (P = 0.321).

Get your kids outside and take advantage of the great summer weather!  Just don't forget the sunglasses!

Incoming ...ball! Protect your eyes while staying active!

In my clinic I frequently see patients who were unfortunate to experience a direct hit to the eye from a stray baseball, raquetball, tennis ball, or a golf ball.  I had seen devastating injuries from players being elbowed during a regular amatuer basketball game.  The list of sports that can threaten your vision and eye health can go on and on.  Fortunately, over the years, the sport industry has learned to protect the players but it is the player himself who opts out of protection gear is the one who suffers.

For those of us who choose to wear glasses and do not wish to undergo LASIK or wear soft contact lenses, you should know about a website zennioptical.com.  I have no financial interest in this business.  I detest spending hundreds unnecesary dollars on glasses.  Therefore, I endorse this website because it provides affordable protective gear for an active person.  One can order prescription goggles in both distance and bifocal correction.  It is, in fact, one of my patients who recently was hit by a raquetball, who recommended this site to me.  He did not wear protective raquetball goggles because he usually wears his large executive style bifocal glasses.  Now he can protect his eyes with polycarbonate lenses that have a built in bi-focal prescription for a fraction of the cost of your neighborhood optical store.

One can also look at magnetic clip on sunglasses that can turn any prescription pair into a protective layer against damaging UV-A and UV-B rays.  I encourage you to get outside this summer, put on your glasses and titanium based sunblock such as Australian lizzard or MD 41 and enjoy yourself!

SCREENS, PHONES, TABLETS AND MORE: reducing digital eye strain.

Few tips from the recent report by the Vision Council:

ADJUST EXTERNAL FACTORS
• Reduce glare. Adjust the brightness of your screen by checking the control settings on your digital
device. Consider changing your background color from bright white to a cooler gray. Glare reduction
filters are also available and can easily attach to computer screens.

• Clean your screen. Frequently dust and wipe digital screens to help reduce glare.

• Dim your surrounding lighting. Lessen the amount of overhead and surrounding light that is competing with your device’s screen. Dim inside lights and try to avoid outside areas of intense brightness. This can help to reduce glare and strain.

• Keep your distance. Position your device so there is sufficient distance between your eyes and the screen.  For computers, try sitting in your chair and extending your arm. Your palm should be able to rest comfortably on the monitor (as if you’re high-fiving the screen).  For hand-held devices, try to keep the device a safe distance from your eyes and hold it just below eye level.

• Adjust your screen. Digital screens should always be directly in front of your face and slightly below eye level. Do not tilt a computer monitor.

• Increase text size. Bump up text size to help better define the content on your screen. Use the settings control to make adjustments that feel comfortable to your eyes.

REMEMBER THE INTERNAL FACTORS:
• Blink more often. Starring at a digital screen can affect the amount of times you blink, causing eyes to dry. Remind yourself to blink more often, which will also help to refocus your eyes.

• Take a 20-20-20 break. Even short breaks can make a huge difference. Every 20 minutes, take a
20-second break and look at something 20 feet away.

For a full report visit http://www.thevisioncouncil.org/consumers//media/VCDigitalEyeStrainReport2012FINAL.pdf

Scholarship to be awarded for 'most beautiful eyes'

A $10,000 educational scholarship is up for grabs in Prevent Blindness America’s (PBA’s) 2012 Most Beautiful Eyes Contest.  Through July 31, parents of children aged up to 17 years can enter their children in the contest by submitting a photo at www.facebook.com/preventblindness. The first 50 entrants will receive a free pair of children’s sunglasses (Real Kids Shades [RKS]).
“Keeping our children’s eyes healthy has been a top priority since our organization was founded in 1908,” said Hugh R. Parry, PBA president and chief executive officer. “Through the Most Beautiful Eyes Contest, we hope to remind parents of the important role that healthy vision has in a child’s development and potential performance in school.”
The public will be able to vote online Aug. 1 to 31. One contestant from each state will advance to the second round of voting. All state winners will receive a free pair of children’s sunglasses (Eagle Eyes Optics Rock-It, including a children’s Fisher Space Pen).
Broadcaster Larry King, “Fox NFL Sunday” host Curt Menefee, and actress Barbara Eden will serve on the celebrity panel of judges selecting the national winner. The national winner and two family members will be invited to PBA’s annual awards banquet Nov. 2 in Chicago, where the scholarship will be awarded.
Marchon Eyewear, Eagle Eyes Optics, RKS, and Walters Golf are sponsoring the contest. For more information, visit the PBA Web site, www.preventblindness.org, or call 800/331-2020.

AIR POLLUTION AND URBAN EYE ALLERGY SYNDROME

Pollution & Conjunctivitis

Air pollution irritates the eye. Although this makes intuitive sense, few studies have been published on the topic. Now a team of researchers reports that pollutants increased demand in Taiwan for outpatient care for nonspecific conjunctivitis.¹

The team, which includes an ophthalmologist, a biochemist, and an environmental engineer, measured the impact of air pollution on ocular health by coupling national health insurance data for outpatient visits between 2007 and 2009 with daily ambient air quality data tracked by the Taiwan Environmental Protection Administration. 

Unlike other conditions affected by air pollution—asthma, for example—the effect on the eye from exposure to pollutants is immediate. 

The researchers found that ozone (O₃) and nitrogen dioxide (NO₂) produced the strongest effects. Large-diameter particulate matter (PM) had an adverse effect, although fine PM did not. 

The authors report that conjunctivitis accountsfor more than 40 percent of ophthalmologic outpatient visits annually in Taiwan.

The study’s conclusion did not surprise Susan M. MacDonald, MD, who noted that the term “urban eye allergy syndrome” is already part of the medical lexicon. “Poor air quality can exacerbate allergic conjunctivitis and dry eye,” said the director of comprehensive ophthalmology, Lahey Clinic Medical Center in Burlington, Mass.

But Dr. MacDonald said that it is easy to overlook air quality when evaluating patients. She called the study “a good reminder that air quality does affect our patients’ eyes and should be considered when we are evaluating patients with ocular irritation.”

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1 Chang C et al. Invest Ophthalmol Vis Sci. 2012;53(1):429-433.
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April is Sports Eye Safety Month

During Sports Eye Safety Month in April, the American Academy of Ophthalmology (AAO), through its EyeSmart program, is reminding athletes to wear appropriate, sport-specific protective eyewear, properly fitted by an eye-care professional, to prevent a sports-related eye injury.
“As an ophthalmologist, I strongly encourage all athletes to use the appropriate protective eyewear for their sports, because eye injuries can be devastating,” said Aaron Weingeist, MD, a clinical correspondent for the AAO. “In fact, some athletes suffer permanent vision loss and blindness from sports-related injuries.”
The AAO recommends lenses made from polycarbonate materials because they can withstand the impact of a ball or other projectile traveling at 90 miles per hour. The organization also recommends purchasing only eye protection that has been tested to meet the American Society of Testing and Materials standards.
“Unfortunately, most youth sporting leagues don’t require children to wear eye protection,” said Dr. Weingeist. “That’s why we’re trying to raise awareness and arming parents and athletes with the information they need to take care of their eyes during sports.”